Posted Date : August 28,2021
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-5633
Government Authority located in Montana; Canada based organization looking for expert vendor for dental claims third party administration service.
[A] Budget: Looking for Proposals
[B] Scope of Service:
Vendor needs to provide g an Offeror to provide third-party administration services, including benefit and claims management, and a provider network and network management for the State Plan’s self-funded.
- Hospital or medical service organizations on a group basis, group practice and other group prepayment plans;
- Any coverage for students which is sponsored by, or provided through a school or other educational institution
- The plan that covers the person as other than a dependent, (e.g., as an employee, member, subscriber, retiree) is primary and the plan that covers the person as a dependent is secondary.
- The plan that covers a person as an active employee that is an employee who is neither laid off nor retired or as a dependent of an active employee is the primary plan. The plan covering that same person as a retired or laid-off employee or as a dependent of a retired or laid-off employee is the secondary plan.
- If a person whose coverage is provided pursuant to COBRA or under a right of continuation pursuant to state or other federal law is covered under another plan, the plan covering the person as an employee, member, subscriber or retiree or covering the person as a dependent of an employee, member, subscriber or retiree is the primary plan and the plan covering the same person pursuant to COBRA or under a right of continuation pursuant to state or other federal law is the secondary plan.
- If the preceding rules do not determine the order of benefits, the plan that covered the person for the longer period of time is the primary plan and the plan that covered person for the shorter period of time is the secondary plan. - To determine the length of time a person has been covered under a plan, two successive plans shall be treated as one if the covered person was eligible under the second plan within twenty-four (24) hours after coverage under the first plan ended. - A change in the amount or scope of a plan’s benefits;
- A change in the entity that pays, provides or administers the plan’s benefits; or
- A change from one type of plan to another, such as, from a single employer plan to a multiple employer plan. - Claims are considered for payment according to the Plan’s terms and conditions, industry-standard claims processing guidelines and administrative practices not inconsistent with the terms of the Medical Plan, Prescription Drug Plan, Dental Plan or Vision Plan.
- Pre-Service Claims must be submitted to the appropriate Plan before the Covered Person receives medical treatment, prescription drug, dental or vision care services. A Preservice Claim is any claim for a medical, prescription drug, dental or vision care benefit which the appropriate Plan terms condition the Covered Person’s receipt of the benefit, in whole or in part, on approval of the benefit before obtaining treatment.
[C] Eligibility:
- Onshore (US Organization Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: October 01,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-5633
Government Authority located in Montana; Canada based organization looking for expert vendor for dental claims third party administration service.
[A] Budget: Looking for Proposals
[B] Scope of Service:
Vendor needs to provide g an Offeror to provide third-party administration services, including benefit and claims management, and a provider network and network management for the State Plan’s self-funded.
- Hospital or medical service organizations on a group basis, group practice and other group prepayment plans;
- Any coverage for students which is sponsored by, or provided through a school or other educational institution
- The plan that covers the person as other than a dependent, (e.g., as an employee, member, subscriber, retiree) is primary and the plan that covers the person as a dependent is secondary.
- The plan that covers a person as an active employee that is an employee who is neither laid off nor retired or as a dependent of an active employee is the primary plan. The plan covering that same person as a retired or laid-off employee or as a dependent of a retired or laid-off employee is the secondary plan.
- If a person whose coverage is provided pursuant to COBRA or under a right of continuation pursuant to state or other federal law is covered under another plan, the plan covering the person as an employee, member, subscriber or retiree or covering the person as a dependent of an employee, member, subscriber or retiree is the primary plan and the plan covering the same person pursuant to COBRA or under a right of continuation pursuant to state or other federal law is the secondary plan.
- If the preceding rules do not determine the order of benefits, the plan that covered the person for the longer period of time is the primary plan and the plan that covered person for the shorter period of time is the secondary plan. - To determine the length of time a person has been covered under a plan, two successive plans shall be treated as one if the covered person was eligible under the second plan within twenty-four (24) hours after coverage under the first plan ended. - A change in the amount or scope of a plan’s benefits;
- A change in the entity that pays, provides or administers the plan’s benefits; or
- A change from one type of plan to another, such as, from a single employer plan to a multiple employer plan. - Claims are considered for payment according to the Plan’s terms and conditions, industry-standard claims processing guidelines and administrative practices not inconsistent with the terms of the Medical Plan, Prescription Drug Plan, Dental Plan or Vision Plan.
- Pre-Service Claims must be submitted to the appropriate Plan before the Covered Person receives medical treatment, prescription drug, dental or vision care services. A Preservice Claim is any claim for a medical, prescription drug, dental or vision care benefit which the appropriate Plan terms condition the Covered Person’s receipt of the benefit, in whole or in part, on approval of the benefit before obtaining treatment.
[C] Eligibility:
- Onshore (US Organization Only);
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: October 01,2021
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$